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Stuart R. Pomerantz CAQ Prep 2004

Intramedullary Edema DDx 1. Transverse myelitis idiopathic, viral, MS2. Sarcoid3. SLE4. Dural AV fistula5. Astrocytoma6. Ependymoma7. Post-traumatic edema8. Mets9. Spinal Cord Infarct

Cystic Masses within Spinal Canal DDx 1. Hydrosyringomyelia2. Ependymoma3. Astrocytoma4.

Hemangioblastoma5. Spinal Cord Herniation

6. Arachnoid Cyst7. Meningeal diverticulum/Cyst8. Cysticercosis9. Neuroepithelial Cyst10.Neuroenteric Cyst

Enhancing Intradural Extramedullary Masses

DDx

1. Drop Metastases (Primary CNS or systemicmalignancy)

2. Schwannomas3. Meningioma4. Exophytic glial neoplasm5. Filar ependymoma6. PNET

Enhancing Intradural Nerve Roots DDx 1. Leptomenigneal Metastases2. Arachnoiditis3. Nerve root compression4. Meningitis (Chemical, infectious, carcinomatous5. CMV radiculitis6. guillain-Barre Syndrome7. AV Fistula

Intramedullary Lesion 1. Tumora. Ependymoma 60%b. Astrocytoma 25%c. Oligodendroglioma - 3%d. Epidermoid, dermoid, teratoma (1-2%)

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e. Lipoma2. Cystic Lesion

a. Syringomyeliab. Hydromyeliac. Reactive Cystd. Hemangioblastoma

3. Vasculara. Cord concussionb. Hemorrhagic contusionc. Cord transectiond. AVM

4. Chronic Infectiona. Sarcoidb. Transverse Myelitisc. MS

Intramedullar Cord Lesion IM ASHAMED1. Inflammation MS, transverse myelitis,sarcoidosis)

2. Medulloblastoma3. Astrocytoma4. syringomyelia, hydromyelia5. Hematoma, Hemangioblastoma6. AVM7. Mets8. Ependymoma9. Dermoid

Intradural Extramedullary Mass 1. Neurofibroma 25-35%2. Meningioma3. Lipoma4. Dermoid commonly conus/cauda, a/w spinal

dysraphism5. Ependymoma6. Drop mets from CNS tumors7. Mets from extra-CNS tumors8. Arachnoid cyst9. neurenteric cyst10.Hemangioblastoma

Intradural Extramedullar Mass MAMA N

1. Mets2. Arachnoiditis3. Meningioma4. AVM, arachnoid cyst

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5. NeurofibromaEpidural Extramedullary Lesion 1. Benign Tumor

a. Dermoid, epidermoidb. Lipomac. Fibromad. Neurinoma/schwannoma with intradura

component

e. Meningioma with intradural componentf. Ganglioneuroblastoma, ganglioneuroma

2. Malignant Tumora. Hodgkin Diseaseb. Lymphoma dorsallyc. Mets breast, lung, from VBd. Paravertebral Neuroblastomae. Chordoma

3.

Disk Diseasea. Bulging disk, herniated disc, sequestereddisc fragment

4. Osseous spinal stenosis, spondylosis5. Inflammation epidural abscess6. Hematoma

Neurogenic Tumor (Neurinoma) types 1. Arising from nerve sheatha. Schwannoma antoni A (cellular) and B

(myxoid), most sporadic, 15-20% NF2

b. Neurofibroma NF1, potential formalignant transformation,

2. Originating from Nervea. Neuroma posttraumtic lesion at end of

severed nerveb. Neurilemoma

Cord Atrophy DDX 1. MS2. Amyotrophic Lateral sclerosis3. Cervical spondylosis4. Sequela of trauma5. Ischemia6. Rtx7. AVM

Lumbosacral Post-surgical Syndrome 1. Biomechanical Failurea. Primary disc herniationb. Recurrent disc herniation (1 week 1

month)2. Failure of Treatment

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a. residual disc herniation (onset < 1 week)b. perioperative intraspinal hemorrhagec. spinal/meningeal/neural inflammationd. Intraspinal scar formation - > 1month

i. Epidural fibrosisii. Fibrosing arachnoiditis

Failed Back Surgery Syndrome

1. Definition2. Causes 1. Failure of improvement following back surgery (15%), difficult in immediate postop pd,

stabilization of findings over 2-6 moths2. DDx

a. Osseous Causesi. Spondylisthesis

ii. Central Stenosisiii. Foraminal stenosisiv.

Pseudoarthrosisb. Soft Tissue Causes

i. Adhesive arachnoiditisii. Infection

iii. Hemorrhageiv. Epidural fibrosis (scarring)v. Recurrent disc herniation

c. Surgical Errorsi. Wrong level/side of surgery

ii. Direct nerve InjuryFailed Back Surgery Syndrome DDx ABCDEFG

1. Arachnoiditis2. Bleeding3. Contamination (infection)4. Disc (residual/recurrent/new level)5. Error (level)6. Fibrosis (scar)

Cauda Equina Syndrome DDx 1. displaced disc fragment2. intra/extramedullar tumor3. Osseous: paget dz, osteomyelitis, osteoarthrosis o

facet joint, ank spon

Long Epidural Lesions of the Spine DDx 1. Epidural Lipomatosis2. Metastases3. AVMs4. Extramedullary hematopoiesis5. OPLL6. Lymphoma

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7. Neuroblastoma8. Epidural Abscess9. Epidural Hematoma

Sacral/Presacral Masses DDx 1. Chordoma2. Giant Cell Astroctyoma3. Mets4. Sacrococcygeal teratoma5. Tarlov Cysts6. Plasmacytoma7. Neuroblastoma8. Ganglioneuroma9. Plexiform Neurofibroma

Osteolytic Lesion of Skull 1.Normal varianta. Emissary vein

b. Venous Lakec. Pacchionian granulationsd. Parietal foraminae (normal or giant)

2. Traumaa. Surgical burr holeb. Leptomeningeal cyst

3. Infectiona. Osteomyelitisb. Hydatid diseasec. Syphilisd. Tb

4. Congenitala. Dermoid/Epidermoidb. NF (asterion defect)c. Meningoencephaloceled. Osteoporosis circumscripta of Paget Dze. Fibrous Dysplasia

5. Benign Tumora. Hemangomab. Brown Tumorc. EG

6. Malignant Tumora. Solitary/multiple metsb. Multiple myelomac. Plasmacytomad. Leukemiae. Neuroblastoma

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Solitary Lytic Lesion in Skull HELP MFT HOLE1. Hemangioma2. Epidermoid/Dermoid3. Leptomeningeal Cyst4. Postop/Paget Dz5. Mets, Myeloma6. Fibrous dysplasia7. Tb8. Hyperparathyroidism9. Osteomyelitis10.Lambdoig defect (NF)11.Eosinophilic Granuloma

Multiple Lytic Lesions in Skull BAMMAH

1. Brown Tumor2. AVM3.

Myeloma4. Mets

5. Amyloidosis6. Histiocytosis

Spinal Segmentation Anomalies 1. Asomia2. Hemivertebra3. Coronal cleft4. Butterfly vertebra5. Block vertebra6. Hypoplastic vertebra7. Klippel-Feil syndrome

Small Vertebral Body DDx 1. RTx2. Juvenile rheumatoid arthritis cspine3. EG vertebra plana4. Gaucher dz compression deformity (deposits of

glucocerebrosides within RES)

5. Plastyspondyly generalisata (hereditary disordersinc. achondroplasia, mucopolysacharidosis,

osteopetrosis, NF, OI)

Vertebral Plana FETISH1. Fracture (trauma, OI)2. EG3. Tumor Lymphoma, Leukemia, mets)4. Infection5. Steroids (avascular necrosis)6. Hemangioma

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Enlarged Vertebral Body DDx 1. Pagets DZ picture framing2. Gigantism3. Myositis ossificans progressive

Vertebral Border Abnormalities

Straightening of Anterior Border 1. Ankylosing Spondylitis2. Paget Dz3. Psoriatic arthritis4. Reiter disease5. RA6. Normal Variant

Anterior Scalloping of Vertebrae 1. Aortic Aneurysm2. Lymphadenopathy3. Tb4.

Multiple Myeloma

Posterior Scalloping of Vertebrae Dural Ectasia1. Increasing Intraspinal Pressure

a. Communicating hydrocephalusb. Ependymoma

2. Mesenchymal tissue laxitya. NFb. Marfan Syndromec. Ehlers-Danlosd. Posterior Meningocele

3. Bone Softeninga. Mucopolysaccharidoses: Hurler, Morqui,Sanfilippo

b. Acromegaly (lumbar vertebrae)c. Ankylosing spondylitis (lax dura acting o

osteoporotic vertebrae)d. Achondroplasia

Bony Projections from Vertebra 1. LOWER 1/3 ANTERIOR BEAKa. Hurler syndrome LOWER 1/3 anterior

beak, mild kyphotic curve

b. Achondroplasiac. Cretinism (hypothyroidism)d. Down syndromee. Neuromuscular diseases

2. CENTRAL ANTERIOR BEAKa. Morquio disease flat/wide vbs

3. Spondylosis Deformans osteophytes along

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anterior and lateral endplstes withhorizontal/vertical course (sharpeys)

4. DISH Diffuse idiopathic skeletal hyperostosis,Forrestier disease, flowing Ca+/ossification alaon

anterolateral aspect of >= 4 contiguosu thoracicvertebral bodies

5. Ankylosing Spondylitis bil symmetricsyndesmophytes (ossification of annulus fibrosus

bamboo spine, discal ballooning (biconvex discs2 osteoporotic endplate deformity

6. FluorosisSpine Ossification Patterns and associations 1. Syndesmophyte ossification of annulus fibrosu

ankylosign sponydilitis, ochronosis

2. Osteophyte - ossification of ALL, osteoarthritis3. Flowing Anterior Ossification DISH4.

Paravertebral ossification psoriatic arthritis,Reiter syndrome

Vertebral endplate Abnormality 1. Osteoporosis senile, steroids, fish vertebrae2. Sickle Cell Disease H vertebrae central

compression due to subchondral infarcts

3. Schmorl Node4. Limbus vertebrae (anteriosuperior corner5. Ring epiphysis normal b/w 6-12 yo, small

steplike recess at corner of anterior vb edge

6. Renal Osteodystrophy rugger jersey spine7. Myelofibrosis rugger-jersey spine thick band8. Osteopetrosis sandwich vertebrae thin sclerot

endplates

Schmorl Node DDx SHOOT

1. Scheurmann disease2. Hyperparathyroidism3. Osteoporosis4. Osteomalacia5. Trauma

Intervertebral Disc Calcification CHOW1. CPPD2. Hemochromatosis3. Ochronosis4. Wilson Disease

Bullet-shaped Vertebral Body HAM1. Hypothyroidism

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2. Achondroplasia3. Morqui syndrome

Bone-within-bone Vertebra 1. Stress line2. Leukemia3. Heavy metal poisoning4. Thorotrast injection , TB5. Rickets6. Scurvy7. Hypothyroidism8. Hypoparathyroidism

EXPANSILE LESION OF VB

EXPANSILE LESION OF VB: Multiple VBInvolvement

1. Mets2. Multiple Myeloma3.

lymphoma4. hemangioma

5. Paget disease6. angiosarcoma7. EG

EXPANSILE LESION OF VB: Involvementof Two/More Contiguous Vertebrae

1. Osteochondroma2. chordoma3. aneurismal bone cyst4. myeloma

EXPANSILE LESION OF VB: Benignlesions

1. Osteochondroma2. Osteoblastoma posterior elements, cervical,calcified tumor matrix

3. Giant Cell Tumor sacrum, malignant degen 15-20%

4. Osteoid osteoma5. Aneurysmal Bone cyst arise from primary bone

lesion (GCT, fibrous dysplasia)6. Hemangioma7. Hydatid Cyst8. Paget disease picture framining, enlargement9. EG 10.Fibrous Dysplasia ground glass

EXPANSILE LESION OF VB: Malignant

Lesions

1. Chordoma2. Metastases pedicles often destroyed3. Multiple Myeloma/Plasmacytoma pedicles

usually spared4. angiosarcoma

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5. Osteosarcoma, chondrosarcoma6. Lymphoma

Bone Tumors Favoring Vertebral Bodies CALL HOME

1. Chordoma2. ABC3. Leukemia4. Lymphoma5. Hemangioma6. Osteobastoma, osteoid, osteoma7. Myeloma, Mets8. EG

Priamry Vertebral Tumors Peds 1. Osteoid Osteoma2. Benign Osteoblastoma3. ABC4.

Ewing sarcoma

Blow Lesion of Posterior Elements GO APE1. GCT2. Osteoblastoma3. ABC4. Plasmacytoma5. EG

Primary Tumor of Posterior Elements A HOG

1. ABC2. Hydatid Cyst, Hemangioma3. Osteoblastoma, Osteoid Osteoma4. GCT

Cervical Spine Fusion SPAR BIT

1. Senile hypertrophic ankylosis (DISH)2. Psoriasis, progressive myositis ossificans3. Ank Spon4. reiters disease, RA (juvenile)5. Block vertebra (Klippel-Feil)6. Infection (Tb)7. Trauma

Fused Vertebrae 1. Isolated congenital (References only)2. Klippel-Feil syndrome (References only)3. Rheumatoid arthritis4. Ankylosing spondylitis5. Tuberculosis6. Operative fusion

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7. Post traumatic (References only)Odontoid Erosion P LARD

1. Psoriasis2. Lupus3. Ankylosis Spondylitis4. RA5. Down syndrome

Spina Dysraphism types 1. Occult spina bifida occulta2. meningocele3. myelocele4. myelomeningocele5. lipomyelomeningocele6. myelocystocele7. myeloschisis

Atlantoaxial Subluxation Causes 1. Congenital occipitalization of atlas, congenitalinsufficiency of transverse ligament, osodontoideum/dens aplasia, down syndrome

(20%)_, morqui syndrome, bondy dysplasia2. Arthritis laxity or transverse ligament, dens

erosiona. RA, psoriatic, Reiter, anklyosing

spondyltiis, SLE3. Inflammatory Process pharyngeal infection,

retropharyngeal abscess, Otitis media, mastoiditi

cervical adenitis, parotitis, alveolar abscess4. Trauma (very rare without dens fx)5. Marfan disease

Atlantoaxial Subluxation JAP LARD

1. Juvenile RA2. Ank spon3. Psoriatic4. Lupus5. Accident (trauma)6. Retropharyngeal abscess, RA7. Down

Sacral Neoplasms SPACEMON1. Sarcoma2. Plasmacytoma3. ABC

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4. Chordoma5. ependymoma6. Metastasis (breast, kidney, cervix, colon)7. osteomyelitis8. Neuroblastoma

Complications of Cervical Spine FixationSurgery

1. Soft tissue complicationsa. Wound Infectionb. Seroma and epidural scarc. Epidural hematoma - CTd. Epidural hematoma - MRI

2. Bone/Bone graft complicationsa. Nonunionb. Endplate Fracturec. Graft Collapsed. Graft Reabsorptione.

Displaced Strut Graftf. Instability

3. Hardware complicationsa. Screw in disc spaceb. Screw displacementc. Screw backing outd. Screw in spinal canale. Screw looseningf. Screw loosening and hematomag. Broken screwh. Slipped rod

Multiple Collapsed Vertebrae 1. Osteoporosis2. Neoplastic Disease3. Trauma4. Scheurmanns Disease5. Infection6. EG7. Sickle Cell anemia

Erosion, destruction or absence of a pedicle 1. Metastasis2. Multiple myeloma3. Intraspinal mass (References only)

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4. Aneurysmal bone cyst5. Giant cell tumor6. Congenital abscence (References only)7. Tuberculosis8. Benign bone

Squaring of one or more vertebral bodies1. Alkylosing spondylitis2. Paget's disease3. Psoriatic arthropathy4. Reiter's syndrome5. Rheumatoid arthritis

Conditions producing disc space narrowing

1. Infection2. Mastocytosis3.

Myelofibrosis4. Lymphomas

5. Paget's disease6. Fluorosis7. Renal osteodystrophy8. Axial osteomalacia

Intervertebral disc calcifications

1. Degenerative spondylosis2. Alkaptonuria3. CPPD4. Ankylosing spondylitis5. Juvenile chronic arthritis6. Hemochromatosis7. Diffused idiopathic skeletal hyperostosis8. Gout9. Idiopathic10.Post spinal fusion

Anterior scalloping of the sacrum

1. Metastasis2. Multiple myeloma3. Posterior soft tissue pelvic tumors

Ivory vertebrae 1. Metastases2. Paget's disease3. Lymphoma4. Low-grade infection

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